Background

Anti-tumor necrosis factor agents are effective for treating patients with ulcerative colitis (UC). We aimed to assess the effect of treatment with adalimumab (ADA) vs. immunosuppressants or steroids (IMS) on health care utilization and cost of care in patients with UC.

Methods

Patients (>18 years) were selected from the Truven Health MarketScan® Commercial Claims and Encounters databases (2005–2009) if they had ≥1 inpatient or ≥2 outpatient claims matching a UC diagnosis (ICD-9 556.x). Patients with concurrent diagnosis of Crohn's disease (ICD-9 555.x) and those receiving other biologics were excluded. Patients were grouped into 2 mutually exclusive cohorts: ADA arm (with or without IMS) or IMS-only arm. Patients had to be continuously enrolled during the 12-month period before (baseline) and after (follow-up) the biologic or IMS initiation. Changes from baseline in UC-related hospitalizations (rate and length of stay [LOS]), outpatient services, corresponding health care costs, and colectomy (rate and LOS) were compared between the 2 arms.

Results

Of the 9,230 eligible UC patients, 143 received ADA and 9,087 received IMS only. There were no between-group differences in age or sex; ADA-treated patients had more comorbidities and greater steroid use at baseline vs. the IMS-treated patients (69.2% vs. 32.1%, P < 0.05). From baseline to follow-up, ADA-treated patients had significant reductions whereas IMS-treated patients had increases in UC-related hospitalizations and LOS (table). UC-related outpatient service utilization and costs, as well as total inpatient and outpatient service costs, decreased significantly for ADA-treated patients vs. a small increase for IMS-treated patients. ADA-treated patients also had a significantly greater reduction in hospital LOS for colectomy.

Conclusion

In this retrospective claims database analysis, ADA therapy was associated with greater reductions in UC-related hospitalization rates, length of hospitalization for colectomy, and total inpatient and outpatient medical service costs compared with IMS therapy.